Therapeutic Challenges in the Management of Acute Pulmonary Embolism in a Cancer Patient with Chemotherapy-induced Thrombocytopenia

  • Abuajela Sreh General Internal Medicine, Walsall Manor Hospital, United Kingdom http://orcid.org/0000-0002-3434-3357
  • Shailesh Nakeshree Geriatrics and General Internal Medicine, Walsall Manor Hospital, United Kingdom
  • Senthil-Kumar Krishnasamy Consultant in Diabetes and General Internal Medicine, Walsall Manor Hospital, United Kingdom
  • Nuri Alfasi Consultant in Haematology and General Internal Medicine, AlKhums General Hospital, Libya

Abstract

This case demonstrates the therapeutic challenges encountered when managing an acute pulmonary embolism in a cancer patient with thrombocytopenia. A 64-year-old man with a history of lung cancer receiving chemotherapy was admitted to Walsall Manor Hospital with haemodynamic instability consistent with a pulmonary embolism, proven on computed tomographic pulmonary angiogram. His platelet count was noted to be 35×109/l (chemotherapy-induced thrombocytopenia). After discussions, he was deemed not suitable for thrombolysis based on risk versus benefits. The patient was initially transfused one adult dose of platelets and treated with half the therapeutic dose of low molecular weight heparin (LMWH). The same management plan was followed until the platelet count exceeded 50×10sup>9/l, after which the patient was established on the full therapeutic dose of LMWH. Clinically, the patient improved and was discharged. Three months after discharge, follow-up revealed sustained clinical improvement while the patient continued to be on the full therapeutic dose of LMWH with a stable platelet count.

Author Biographies

Shailesh Nakeshree, Geriatrics and General Internal Medicine, Walsall Manor Hospital, United Kingdom

Medical Registrar

Senthil-Kumar Krishnasamy, Consultant in Diabetes and General Internal Medicine, Walsall Manor Hospital, United Kingdom

Consultant

Nuri Alfasi, Consultant in Haematology and General Internal Medicine, AlKhums General Hospital, Libya

Consultant 

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  • Published: 2017-11-14

    Issue: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    Sreh, A., Nakeshree, S., Krishnasamy, S.-K., & Alfasi, N. (2017, November 14). Therapeutic Challenges in the Management of Acute Pulmonary Embolism in a Cancer Patient with Chemotherapy-induced Thrombocytopenia. European Journal of Case Reports in Internal Medicine, 2. https://doi.org/https://doi.org/10.12890/2017_000713